Purpose: To find out the outcomes of suprachoroidal Triamcinolone injection in refractory diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Al-Ehsan Eye Hospital, Lahore from Jan 2020 to 31st Dec 2020. Methods: Sixty-five patients with refractory diabetic macular edema were included. Patients underwent complete ocular history and examination. To document baseline macular edema, SD-OCT was done. The recruited patients received 0.1ml of suprachoroidal Triamcinolone injection (40mg/ml) using a 30 gauge syringe. Follow up was performed at one week, one month and third month after injection. At each follow up, best corrected visual acuity, central macular thickness and retinal nerve fiber thickness were documented. Data was analysed using SPSS version 36.0. Comparison of BCVA, central macular thickness and retinal nerve fibre layer thickness (RNFL) before and after injection was analyzed by paired sample t-test with p value of ≤ 0.05 as significant. Results: Out of 65 patients, 29 (44.62%) were females. Mean age of patients was 54 ± 8.4 years (range 40 to 80 years). Central macular thickness after suprachoroidal Triamcinolone injection changed from 556.2 ± 10.9 to 313.6 ± 7.2 ųm. Change in visual acuity was 0.9 ± 0.01 to 0.6 ± 0.02. Pre-treatment and post-treatment visual acuities demonstrated a substantial change after undergoing treatment along with decrease in central macular thickness with p value ˂ 0.001. Conclusion: Suprachoroidal Triamcinolone injection results in anatomical as well as functional improvement in diabetic patients with refractory macular edema.
Purpose: To find out the frequency of complications in a high volume phacoemulsification set up at a tertiary care eye hospital in Lahore. Study Design: Quasi experimental study. Place and Duration of Study: Al-Ehsan Eye Hospital, Lahore, from July 2017 to June 2019. Methods: Surgical outcomes of 6902 patients who had undergone phacoemulsification were included. Patients were excluded if they had ocular infections, lid margin diseases, adnexal diseases, those requiring a secondary anterior chamber surgery and those unfit for the procedure due to medical grounds. Every patient underwent a detailed history and complete clinical examination. All patients underwent the standard phacoemulsification technique and at the end of each surgery, subconjunctival injections of dexamethasone and gentamycin were given to the patients. Complications encountered during high volume cataract surgery were recorded and their percentages were calculated. Results: A total of 6902 patients underwent cataract surgery with 2.66% intra-operative and 6.94% immediate post-operative complications. The most common intra-operative complication was posterior capsular rupture (1.15%). In patients with capsular rupture the intra ocular lens was implanted within the sulcus in 61 cases (0.88%) while in 12 cases (0.17%) anterior chamber lens was implanted because of lack of capsular support. During the surgery intra ocular lens could not be implanted in 7 cases (0.10%) and they were left aphakic. The commonest immediate post-operative adverse outcome was corneal edema with striate keratopathy and decements folds in 197 cases (2.85%). Conclusion: High volume cataract surgery using appropriate techniques and sterilization does not compromise the quality of outcomes. Key Words: Cataract, Phacoemulsification, Vitreous loss.
Background: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges. Methods: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA). Results: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively. Conclusion: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.
. Purpose: To find out the efficacy of oral Alprazolam and Mefenamic acid in relieving pain during pan retinal photocoagulation in patients with proliferative diabetic retinopathy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology, Al-Ehsan Eye Hospital, Lahore, from January 2018 to December 2018. Methods: Patients were divided into two groups; groups A received one tablet of Xanax (Alprazolam 0.5 mg) and 2 tablets of Ponston Forte (Mefenamic acid 500 mg) an hour before PRP. In group B no pain relieving medicines were prescribed. Proparacaine hydrochloride 0.5% eye drops were instilled in the eye to achieve corneal anesthesia before the procedure in both the groups. Pain was scored, 15 minutes after PRP, using standard verbal rating scale and results were analyzed. Paired sample t-test was used to measure the mean difference in pain between the two groups. A p value of less than 0.01% was considered significant. Results: Five hundred and sixty patients with proliferative diabetic retinopathy (PDR) requiring Pan Retinal Photocoagulation (PRP) were enrolled. There were 272 males and 288 females. Mean age of patients was 64.0 ± 6.8 years. Mean pain score for group A was 4.0 ± 0.6 and for group B was 2.1 ± 0.3. Difference in pain score felt by each group was -1.93 ± 0.7 with significant p value of ˂ 0.01%. Conclusion: Oral administration of Alprazolam and Mefenamic acid one hour before PRP in patients with proliferative diabetic retinopathy was effective in reducing pain and in attaining patient cooperation during the procedure. Key Words: Pan Retinal Photocoagulation, Pain, Proliferative Diabetic Retinopathy, Alprazolam, Mefenamic acid.
Purpose: To compare the accommodation convergence per accommodation ratio (AC/A) in true and simulated divergence excess exotropia. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of ophthalmology, Punjab Rangers teaching hospital, Lahore, from July 2019 to December 2019. Methods: The study included 20 patients each of intermittent exotropia (XT) true and simulated divergence excess exotropia (XT).All the subjects underwent complete orthoptic assessmentthat included AC/A ratio calculation through heterophoria method after monocular occlusion. Results: The Results showed that patients with true divergence excess exotropia have a high AC/A ratio as compared to patients with simulated divergence excess exotropia who have a normal AC/A ratio. 57% patients showed true divergence excess exotropia with high AC/A ratio while 43% had divergence excess with normal AC/A ratio. Conclusion: The response of AC/A was found to be higher in patients with true divergence excess exotropia after monocular occlusion. Key Words: Intermittent exotropia, True simulated divergence excess exotropia, simulated divergence excess exotropia.
Purpose: To compare the Central subfoveal choroidal thickness (CCT) in diabetic patients with and without diabetic retinopathy. Study Design: Cross sectional observational study. Place and Duration of Study: Al-Ehsan Welfare Eye Hospital, Lahore, from June 2019 to May 2020. Methods: One hundred and twenty patients with type II diabetes were included with a mean age of57±0.9. Patients were divided into two groups (60 in each group) based on presence or absence of diabetic retinopathy after ophthalmic examination. Group A comprised of patients showing signs of retinopathy and group B with no signs of diabetic retinopathy. After detailed ophthalmic examination, spectral–domain OCT was performed for the measurement of central subfoveal choroidal thickness. The differences in measurements were analyzed and measured by using SPSS version 22. Results: Out of 120 patients, 69 (57.5%) were males and 51 were females (42.5%). Mean age of patients was 58.8 ± 10 years with minimum 28 years and maximum 94 years. Central choroidal thickness in group A showed a mean value of 239 ± 41 µm with standard error of mean 3.76. While diabetic patients having no signs of diabetic retinopathy (Group B) showed mean subfoveal choroidal thickness of 240 ± 42 µm with standard error of mean 3.89. The difference in central subfoveal choroidal thickness in both groups was 1.337 which is statistically insignificant with p value of 0.250. Conclusion: Central choroidal thickness amongst diabetic patients with and without signs of retinopathy does not have any significant changes. Key Words: Choroid, Diabetic retinopathy, Optical Coherence Tomography.
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